Splinting
Splinting is a useful adjunct to standard therapies and can be broadly thought in two groups; functional or non-functional. Functional splinting (daytime splints) aims to improve motor function by supporting joints in the optimal position during use. Non-functional splinting (night splints or serial casts) provides prolonged stretch with the aim of preventing or treating a contracture. Splinting may sometimes also be used temporarily after an operation.
Whether splints are useful for an individual child is very variable. Whilst there are many situations when daytime splints are useful in improving the functional position of the hand and arm, the reality is that they are often cumbersome and many children do not tolerate them. They can interfere with hand washing and can be difficult for children to remove and reapply independently. It can also have a negative effective on sensation and proprioception. Night-time or resting splints however are generally well tolerated without issue.
If you have a splint but are not using it we recommend that you discuss with your local therapy team. There may be options to adjust this to better to your needs or try alternative strategies to try and prevent future problems.
Serial Casting
If your childs arm has a fixed contracture (where the joint is stuck in a certain position and never relaxes or becomes straight) serial casting may be considered. This is a process in which a number of casts are used over time to stretch out the affected joint. Typically serial casts will be changed very weekly or fortnightly and are usually on in the region of 3-6 weeks depending on the individual.
It can be done in isolation or sometime it may be considered in conjunction with Botox injections. The Botox injections aim to reduce muscle over activity and stiffness. This may help to improve the stretch gained by casting and reduce pain.
The goal of serial casting is dependant on the individual case but generally benefits include -
- To improve passive range of movement
- To improve positioning making daily activities easier
- Prevent or lessen abnormalities in joint flexion (contractures)
- Normalise muscle tone
- Reduce spasticity
Most children tolerate casts very well but they may feel some discomfort or a stretching sensation. Your local plaster room will give you advice on how to care for your cast and what to look out for. However occasional problems with casts can arise and it is important to check the fingers and the cast edges regularly. If your child is have increasing pain, unable to sleep, increasing distress or any feelings of tingling, numbness, colour changes or swelling in the fingers you should contact your local team.
Bracing
In some situations bracing may be a suitable alternative to serial casting. Over time the brace is gradually adjusted every week to apply a little more stretch to the affected muscles that are tight.
There are many different types of braces available and suitability depends on many factors including the joint involved. Some examples include mouldable and remoudable braces. These can placed in the oven, heated up and then applied to the limb which is fastened with a zip. It is positioned and then hardens as the brace cools. Some of the benefits include that they are often lightweight, reusable, waterproof and easily removable for washing or if there is a problem.
Other types of braces include spring loaded braces. This is where a specially designed brace that has hinges and springs that apply a constant low load prolonged stretch.
